Your first doctor’s visit after a T1D diagnosis will have the usual physical exam — with special emphasis on the eyes, skin and feet — and the standard interview about your medical history, lifestyle and diet. But there will also be some additional tests and some new vocabulary for you to learn.
First, you will definitely have your blood and urine tested for important things like cholesterol, fat, urine proteins (an indicator of kidney damage), blood glucose, and something called your “glycated hemoglobin level” — better known as your “A1c.”
The A1c is a kind of benchmark that is usually checked quarterly to score the averaged levels of your blood glucose over the prior few months. You might have already had this, as some doctors will include it to confirm their diagnosis. The results are usually given as a percentage, with 7% or lower being the goal.
As you learn to manage your glucose levels with insulin, diet, and exercise, this test becomes a kind of status report that can help you see how you’re doing. The “score” does have some margin for error and can fluctuate, so it’s important not to place too much emphasis on it. Most importantly, if your results aren’t what you hoped, don’t get discouraged. The A1c is one tool among many that you and your doctors will be using to gauge how effective your treatment has been.
After the exams and the testing it’s time to focus on education, and creating a plan for your future care. Typically you’ll want referrals to a CDE (certified diabetes educator), a dietician, a counselor or therapist, and doctors who specialize in eye and foot problems. You may not have all of these from the start, but it’s good to keep them in mind.
Your doctor will want to work with you to build a custom treatment plan. Just as your T1D is unique to your body, the way you treat it will need to be customized to your life. Everyone has different fitness levels, work schedules, cultural activities, and diet — all of which change over time — so there really isn’t a one-size-fits-all treatment. You need to be involved and aware of changing needs to maintain optimal health.
There will be many regular checkups to come, but you should leave your first visit with a plan, some goals, and the following key information:
- How to give yourself an injection. It sounds scary, but there’s not much to it after some practice. Your Doctor will want to show you the basics and calm your fears.
- An explanation about tracking glucose (sugar) levels in your blood and ketone levels (a chemical produced when your body lacks insulin) that can be found in blood and in your urine. Yes, you’ll be testing your blood and your urine from now on. Yay!
- The names and dosages of your medications.
- A schedule for future appointments and examinations.
The Months Ahead
There are some tests that your Doctor will reserve for annual visits, like screening for cholesterol levels, possible kidney issues, or eye exams, but another A1c test, along with a general physical check-up and a revision of your glucose levels and insulin dosages should occur every four months.
At each future appointment, you and your doctor should be prepared to discuss:
- Results of any recent tests.
- The record of your blood glucose levels (that you’ve been faithfully testing and recording), and any instances of very high or very low levels. It’s crucial not to hide or downplay any problems. Highs and lows are not a reflection of whether you were “good.” They indicate how your lifestyle and medication are interacting. Doctors specialize in spotting patterns and connections you can’t see. Their adjustments can help you avoid future problems.
- Any changes to your medication that might be needed based on those numbers.
- Your blood pressure, and any circulation or blood flow issues, particularly in the feet.
- Activity levels, exercise, stress and dietary struggles.
- Any thoughts or concerns you might have.
One helpful suggestion is make any relevant notes about mood, physical activities, and other stressors (in addition to blood glucose levels throughout each day). This way you won’t forget to ask if you’re feeling hurried or stressed during a consultation.
Admittedly, regular doctor visits, quarterly blood tests and keeping close notes on your blood glucose levels might not sound fun … but regular medical visits are key in managing T1D. It’s tempting to skip appointments when life gets busy, but don’t. Meeting with your doctor can be reassuring and motivating.
The fact is, regular checkups and diligent tracking of your levels lead to fewer complications and will allow you to tackle this challenge with confidence.
This is part of our First 30 Days series. Click here for an overview of all Beyond Type 1 First 30 Days Content.